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- May 9, '11 by esieOne of the current trials being conducted by ANZICS Clinical Trials Group in Australia & New Zealand is the CHEST study. The study is comparing the use of Hydroxy-Ethyl Starch (Voluven, Hespian) 0.9% Sodium Chloride, with 0.9% Sodium Chloride alone, in fluid resuscitation in critically I'll adults over a 90 day mortality period. Having spoken to a couple of the Intensivists at my old unit, which is enrolled in the trial, the expected outcome is that this trial will have a similar outcome to the SAFE trial.*In the units I have worked in, generally only saline or albumin are used, although OT sometimes used Plasmalyte.
- Aug 10, '11 by badnesswe only use it in cabg's
- Aug 10, '11 by suannaHespan usd to be our primary colloidal volume expander. Unfortunately for the makers of hetastarch, it picked up a "black box" warning from the FDA a few years ago about coagulopathy with use over 1500cc/24hrs. It was rare we ever gave that much, but with a bleeding patient is was possible in an emergancy we could have reached that level. We stopped using it for the fear that a bleeding patient would have a bad outcome and some ambulance chaser could point to the hespan and say " no wonder the patient bled to death- they gave hespan!- is causes coagulopathy" Even if the bleeding started before the hespan, even if they had less than the warned about amount, you can bet the fact that the bleeding didn't magicly stop was because of the hespan given to keep fluid in the vessels until a surgeon was on the scene.
Albumin is the new kid on the block. I have no idea what new "black box" warnings they are going to put on it, but I'm sure we'll have to find some other colloid to keep our patients alive with in a few more years.
Personaly, I think the solution to Americas health care crisis is 80% tort reform.- but that is for another thread....
- Aug 10, '11 by mmutkWe use Hespan on occasion for our post op CABGs, but if it doesn't work soon it's time to move on to the pressure...